AS GPs wonder what will happen to their patients in need of emergency admission, MARGARET SMITH reports on the crisis facing Wycombe Hospital and the care agencies.

Bed blocking at Wycombe Hospital is an increasing problem which has a knock-on effect on the rest of the hospital services.

And as Buckinghamshire social services finds itself increasingly unable to pay enough to recruit staff to care for people when they are ready to come out of hospital, or to fund enough places in residential homes, the situation seems likely to get worse rather than better.

The fact that there are currently 55 people ready to leave Wycombe Hospital who are stuck there because of lack of social services care, means others cannot come in for treatment, a fact which has not escaped MPs as GPs ask them anxiously what can be done.

This week David Griffiths, director of hospital services at Wycombe Hospital, said Wycombe was under pressure all the time and something was desperately needed to cut down on bed blocking.

"This is happening more often than we would like. It is a big problem.

"We have been teetering on the brink of stopping GP emergency admissions and we have faxed messages to GPs saying they could help us by holding off emergency admissions."

These admissions arise when a GP visits a patient at home and decides they need to go to hospital. It is not a 999 emergency though it is called a GP emergency admission and the doctor arranges for the patient to be taken in by ambulance.

Mr Griffiths said getting GPs to hold off would give the hospital more time to do routine operations on people who were waiting for almost non-existent beds.

On Monday, the hospital was within a whisker of going even further and diverting patients to other hospitals in Buckinghamshire, Oxfordshire and Berkshire. When a hospital is is danger of seizing up the other hospitals are contacted to take patients.

Mr Griffiths said this happened when the hospital judged that it was more dangerous to take in GPs' admissions than to send them somewhere else.

"The hospitals don't like this and try to avoid it but sometimes there is no other option," he said.

Diversions have happened twice at Wycombe this year. And Wycombe itself has taken patients diverted from other hospitals.

Most of the long waiters in hospital have been there a couple of months over their discharge date, but one patient should have been discharged in November and another in January.

Mr Griffiths said the majority were waiting to move into social services care.

"It is not the patient's fault and it is not for me to say it is anyone's fault," he said.

"But in the hard-pressed NHS this is producing a back-filling effect, which means we can't move some patients through their acute treatment as quickly as we might.

"In June we postponed 70 routine elective patients and that is the last thing we want to be doing. We desperately need to see a reduction in the number of delayed discharge patients."

He said it was rare that the more urgent of the elective operations for example patients with possible cancer would be postponed.

If they were, then the patients would be given a new date within a couple of days.

Staff shortage means patients have to wait

THERE are several reasons why people end up spending longer than necessary in hospital.

The most obvious in this region of high employment is the inability to recruit social services staff and home care staff.

Four of the 12 social workers' posts in Wycombe Hospital are vacant, while in the Wycombe area social services department there are only two people on the pay roll.

Buckinghamshire County Council leader David Shakespeare, who is leading a national campaign for more social services cash, said: "We havn't got the staff to make a care package for people who could come out of hospital.

"We can't recruit care staff because pay levels are too low."

Nursing and residential home places here are scarce and expensive. Private patients and London boroughs can pay more than the county council.

MPs Dominic Grieve and David Lidington both said new government regulations insisting on rooms of a certain size and with en suite bathrooms had forced homes to close.

Two weeks ago the Free Press reported that Beaconsfield House, a care home in Ledborough Lane, Beaconsfield, would close in a month much to the distress of the 19 residents and their families.

A spokesman for the owners said directors could not keep it going any longer because of "financial pressures".

Buckinghamshire social services had to allocate two social workers to look for alternative accommodation, and said it would not be easy.

Sometimes the bedblocking is caused because a patient wants a particular home but there are no vacancies and he or she has to go on a waiting list.

Patients do not have a legal right to stay in an NHS bed indefinitely, but the hospital does not want to pressurise frail people to leave.

The joint health/ social services assessment process before a patient is discharged can lead to delays because it only meets every two weeks.